A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department
Abstract Objective This study analyzed physician treating behavior through the use of a multiplex gastrointestinal polymerase chain reaction (GI PCR) test compared with usual testing in emergency department (ED) patients with suspected acute infectious diarrhea to assess differences in antibiotic ma...
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Elsevier
2022-02-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12616 |
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| author | Andrew C. Meltzer Sophia Newton Joel Lange Nicole C. Hall Nataly Montano Vargas Yihe Huang Seamus Moran Yan Ma |
| author_facet | Andrew C. Meltzer Sophia Newton Joel Lange Nicole C. Hall Nataly Montano Vargas Yihe Huang Seamus Moran Yan Ma |
| author_sort | Andrew C. Meltzer |
| collection | DOAJ |
| description | Abstract Objective This study analyzed physician treating behavior through the use of a multiplex gastrointestinal polymerase chain reaction (GI PCR) test compared with usual testing in emergency department (ED) patients with suspected acute infectious diarrhea to assess differences in antibiotic management. Methods A prospective, single‐center, randomized control trial was designed to investigate antibiotic use in ED patients with moderate to severe suspected infectious diarrhea, comparing those who received GI PCR to those who received usual testing. ED patients with signs of dehydration, inflammation, or persistent symptoms were randomized to either the experimental arm (GI PCR) or the control arm (usual testing or no testing). Results A total of 74 patients met study criteria and were randomized to either the experimental GI PCR arm (n = 38) or to the control arm (n = 36). Participants in the GI PCR arm received antibiotics in 87% of bacterial or protozoal diarrheal infections (13/15) whereas those in the control arm received antibiotics in 46% of bacterial or protozoal infections (6/13) (P value 0.042) with 2‐proportion difference 0.41 (95% confidence interval 0.07 and 0.68). Conclusions ED use of multiplex GI PCR led to an increase in antibiotic use for bacterial and protozoal causes of infectious diarrhea compared to usual testing. This increase in antibiotics appears to be appropriate given patients’ moderate to severe symptoms and a definitive identification of a likely bacterial or protozoal cause of symptoms. Results should be interpreted with caution because of the small sample size. |
| format | Article |
| id | doaj-art-9e23a36a09f24a1098b8dcd461579883 |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2022-02-01 |
| publisher | Elsevier |
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| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-9e23a36a09f24a1098b8dcd4615798832025-08-20T02:17:04ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522022-02-0131n/an/a10.1002/emp2.12616A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency departmentAndrew C. Meltzer0Sophia Newton1Joel Lange2Nicole C. Hall3Nataly Montano Vargas4Yihe Huang5Seamus Moran6Yan Ma7Department of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USADepartment of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USADepartment of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USADepartment of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USADepartment of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USADepartment of Biostatistics and Bioinformatics George Washington University (GWU) Milken Institute School of Public Health Washington District of Columbia USADepartment of Emergency Medicine George Washington University (GWU) School of Medicine & Health Sciences Washington District of Columbia USADepartment of Biostatistics and Bioinformatics George Washington University (GWU) Milken Institute School of Public Health Washington District of Columbia USAAbstract Objective This study analyzed physician treating behavior through the use of a multiplex gastrointestinal polymerase chain reaction (GI PCR) test compared with usual testing in emergency department (ED) patients with suspected acute infectious diarrhea to assess differences in antibiotic management. Methods A prospective, single‐center, randomized control trial was designed to investigate antibiotic use in ED patients with moderate to severe suspected infectious diarrhea, comparing those who received GI PCR to those who received usual testing. ED patients with signs of dehydration, inflammation, or persistent symptoms were randomized to either the experimental arm (GI PCR) or the control arm (usual testing or no testing). Results A total of 74 patients met study criteria and were randomized to either the experimental GI PCR arm (n = 38) or to the control arm (n = 36). Participants in the GI PCR arm received antibiotics in 87% of bacterial or protozoal diarrheal infections (13/15) whereas those in the control arm received antibiotics in 46% of bacterial or protozoal infections (6/13) (P value 0.042) with 2‐proportion difference 0.41 (95% confidence interval 0.07 and 0.68). Conclusions ED use of multiplex GI PCR led to an increase in antibiotic use for bacterial and protozoal causes of infectious diarrhea compared to usual testing. This increase in antibiotics appears to be appropriate given patients’ moderate to severe symptoms and a definitive identification of a likely bacterial or protozoal cause of symptoms. Results should be interpreted with caution because of the small sample size.https://doi.org/10.1002/emp2.12616Antibiotic Stewardshipdiagnostic testingemergency medicineinfectious diarrheaPCR testingPoint‐of care testing |
| spellingShingle | Andrew C. Meltzer Sophia Newton Joel Lange Nicole C. Hall Nataly Montano Vargas Yihe Huang Seamus Moran Yan Ma A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department Journal of the American College of Emergency Physicians Open Antibiotic Stewardship diagnostic testing emergency medicine infectious diarrhea PCR testing Point‐of care testing |
| title | A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department |
| title_full | A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department |
| title_fullStr | A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department |
| title_full_unstemmed | A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department |
| title_short | A randomized control trial of a multiplex gastrointestinal PCR panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department |
| title_sort | randomized control trial of a multiplex gastrointestinal pcr panel versus usual testing to assess antibiotics use for patients with infectious diarrhea in the emergency department |
| topic | Antibiotic Stewardship diagnostic testing emergency medicine infectious diarrhea PCR testing Point‐of care testing |
| url | https://doi.org/10.1002/emp2.12616 |
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